Objective The purpose of this experiment was to explore inhibitory effects of Fe₃O₄ nanometer magnetic carrier-induced hyperthermia under extremely low frequency electromagnetic fields (ELF-EMF) on implanted tumors in nude mice Methods A tumor model in nude mouse was established by implanted Bel-7402 liver cancer cells and the tumor-bearing nude mice were randomly divide into control, intervened in magnetic field and intervened in nano magnetic fluid under extremely low frequency electromagnetic fields (ELF-EMF), with 20 mice in each. The animals in experiment received intratumor injection of PEG-PEI / Fe₃O₄ 0.1 ml under 0.7 mT magnetic field for 1 hour, twice a day and continued for 15 days. Serum VEGF, HIF-1α, sIL-2R and MMP-2 levels were detected. Results At day seven and fifteen, the tumor volume in nude mice in nano-magnetic fluid-treated group were (113.5±12.2) mm³ and (97.6±9.7) mm³, significantly smaller than in control group or in magnetic field-treated group [(204.6±13.5) mm³ and (452.8±16.5) mm³, or (146.7±13.4) mm³ and (118.8±13.6) mm³, respectively, P < 0.05]; the tumor weight was (0.8±0.1) g, significantly lower than [(2.0±0.2) g or (1.4±0.1) g, P <0.05] in control or in magnetic field-treated group, and the tumor inhibition rates in magnetic field and nanomagnetic fluid group were 26.2% and 56.9%, respectively (P < 0.05); serum VEGF, HIF-1α, sIL-2R, and MMP-2 were (127.4±14.2)pg/ml,(32.4±5.2)ng/L,(227.5±23.7)ng/L and (132.4±15.7)pg/ml], all significantly lower [(294.6±18.6)pg/ml,(107.5±12.7)ng/L,(823.6±38.7)ng/L and (453.6±25.4)pg/ml,respectively, P <0.05] in control or [(215.7±14.3)pg/ml,(72.4.±7.5)ng/L,(426.3±24.4)ng/L and (214.3.±18.4)pg/ml,respectively, P <0.05] in magnetic field; the histopathological examination showed the tumor cells in the control group grew vigorously, with large dense cells and disordered arrangement, the tumor cell growth in the magnetic field was restricted, sparsely arranged, with increased interstitial tissues, and the tumor in the nano-magnetic fluid group showed wide necrosis, with reduced tumor cells. Conclusion Fe₃O₄ nano-magnetic fluid intervention under ELF-EMF has a good inhibition effects on angiogenesis in implanted tumor in nude mouse, which could inhibit tumor growth and liver cancer cell proliferation, and promote apoptosis of the liver cancer cells.

Objective The aim of this experiment was to investigate the protective effect of bromo- and extra-terminal domain (BET) inhibitor, (+)-JQ1 on lipopolysaccharide / D-galactose (LPS / D-Gal) -induced acute liver failure (ALF) in mice and its mechanism. Methods 47 C57BL / 6 mice were randomly divided into control ((n=17), ALF model (n=15) and (+)-JQ1 intervention group (n=15). The ALF model were established by intraperitoneal injection of LPS / D-Gal, and mice in (+)-JQ1 intervention group were injected intraperitoneally with (+)-JQ1 2 hours before the induction of ALF. Four hours after LPS/D-Gal injection , 5 mice were sacrificed in each group and the remaining mice were fed for 72 hours to observe 72-hour survival rate. Serum TNF-α was detected by ELISA, and hepatic protein and gene mRNA were assayed by RT-qPCR and Western bloting, respectively. Results The 72-hour survival rate in model group was 16.7%(2/12), not significantly different compared to 60.0% (6/10,P>0.05) in (+)-JQ1-intervened group; serum ALT level in mice with ALF was (2779.0±200.6)U/L and serum AST level was (2885.0±143.6)U/L, both significantly higher than 【(44.9±2.5) U/L and (76.0±5.7) U/L,P＜0.05】 in control, while they decreased significantly to 【(948.7±46.3)U/L and (1704.0±42.1)U/L, respectively, P＜0.05】 in (+)-JQ1-intervened group; the hepatic tissue TNF-αmRNA was (103.7±23.0), significantly higher than 【(1.2±0.2),P＜0.05】, the IL-6 mRNA was (73.4±15.8) , much higher than 【(1.1±0.1), P＜0.05】, and the IL-1B mRNA was (13.5±2.7) , significantly higher than 【(1.0±0.1), P＜0.05】 in the control, while they decreased greatly to 【(12.8±1.2), ( 11.7±0.7) and (1.5±0.3), respectively, P＜0.05】 in (+)-JQ1-intervened group; serum TNF-α level was (631.6±57.5)U/L, much higher than 【(2.5±0.5)U/L, P＜0.05】 in the control, while it decreased to 【(139.8±8.1)U/L, P＜0.05】 in (+)-JQ1-intervened group; the expression of P65 and IKB in hepatic tissues in model intensified obviously, while they weaken greatly in (+)-JQ1-intervened group. Conclusion The bromo- and extra-terminal domain (BET) inhibitor, (+)-JQ1 has a protective effect on the liver in mice with LPS / D-Gal-induced ALF, which might be related to the regulation of NF-KB signaling pathway to reduce the expression of proinflammatory cytokines.

Objective To explore the effects of resveratrol (RES) on liver regeneration (LR) and liver tissue naturacl killer (NK) cell cytoxicity in rats with partial hepatectomy. Methods 90 SD rats were randomly divided into control, low-dose of RES-intervened and high-dose of RES-intervened group, with 30 rats in each group, receiving normal saline, or RES at dose of 10 g.kg^-1·d^-1 or RES at dose of 20 g.kg^-1·d^-1 for five days. The 70% partial hepatectomy model was established thereafter. At 24 h and 48 h after surgery, 15 rats in each group were sacrificed. LR index was detected. The percentage of liver tissue NK cells was determined by flow cytometry. The cytoxicity of liver NK cells was determined by ⁵¹Cr release method and the Western blotting was applied to detect expression of PCNA and CyclinD1 protein. Results At 24 h and 48 h, the LR indexes in high-dose of RES group were (1.89±0.04) and (2.45±0.07), which were significantly higher than those in low-dose of RES group [(1.59±0.06) and (2.12±0.05), P<0.05] or in control group [(1.43±0.03) and (1.92±0.05), P<0.05]; the percentages of NK cells were (24.62±1.36)% and (25.47±1.19)%, which were significantly higher than those in low-dose of RES group [(22.21±1.98)% and (22.36±1.78)%, P<0.05] or in control group [(17.36±1.78)% and (18.65±1.69)%, P<0.05]; the cytoxicity activities of NK cells were (48.48±2.69) % and (49.01±2.78)%, which were significantly higher than those in low-dose of RES group [(41.88±2.65)% and (42.32±2.58)%, P<0.05] or in control group [(28.32±2.36)% and (30.12±2.36)%, P<0.05]; the relative expression ofhepatic PCNA and CyclinD1 protein were significantly higher than those in low-dose of RES group or in the control group (P<0.05). Conclusion RES could promote NK cell proliferation and LR in rats after partial hepatectomy.

Objective The purpose of this study was to investigate the diagnostic value of ultrasonic velocity matching and MR diffusion imaging in evaluating liver fibrosis in patients with chronic hepatitis B (CHB). Methods 78 patients with CHB were admitted in our hospital between February 2017 and February 2020, and all received ultrasonic velocity matching check-up for regional velocity index and MR diffusion imaging for apparent diffusion coefficient (ADC) measurement. The liver biopsies were performed in all patients and the liver fibrosis were divided into four stages, e.g. portal area fibrosis for S₁, fibrosis around the portal area for S₂, fibrous septum formation with lobular structure disorder for S₃ and early liver cirrhosis for S₄. The ADC value and regional velocity index were compared in different stages. The diagnostic value of ADC and regional velocity index and their combination in judging liver fibrosis were analyzed by receiver operating characteristic curve (ROC). Results There were 20 cases of S₁ stage, 18 cases of S₂ stage, 24 cases of S₃ stage and 16 cases of S₄ stages in our 78 patients after histopathological examination; the regional velocity index in patients with S₁ was (21.7±5.9) m/s, which was significantly lower than 【(26.8±7.3) m/s, P<0.05】 in patients with S₂, or 【(33.5±8.1) m/s, P<0.05】 in patients with S₃ or 【(36.0±9.2) m/s, P<0.05】 in those with S₄; there were significant differences in regional velocity index among four groups of different stages of liver fibrosis(P<0.05); the ADC value in patients with S₁ was (1.3±0.2)× 10^-3mm²/s, which was significantly higher than 【(1.2±0.2)×10^-3mm²/s, P<0.05】 in patients with S₂, or 【(1.1±0.1)×10^-3mm²/s, P<0.05)】 in patients with S₃ or 【(0.9±0.1)×10^-3mm²/s, P<0.05】 in patients with S₄; there were significant difference in ADC among the four groups of different stages of liver fibrosis (P<0.05); the ROC analysis showed that the area under the curve (AUC)of regional velocity index in judging >S₂ stage of liver fibrosis was 0.724 (95%CI=0.597-0.851),with the sensitivity and specificity of 0.750 and 0.532, respectively, and the AUC of ADC in judging >S₂ stage of liver fibrosis was 0.715 (95%CI=0.569-0.861), with the sensitivity of 0.758 and the specificity of 0.625, whereas the AUC of the two combination in judging >S₂ stage of liver fibrosis was 0.809 (95%CI=0.678-0.910), with the sensitivity of 0.813 and the specificity of 0.710; the AUC of the combination of the two parameters in judging >S₂ stage of liver fibrosis in patients with chronic hepatitis B was significantly higher than those by any of the two examination alone (P<0.05). Conclusion It is practical to evaluate the liver fibrosis staging or the early screening of liver cirrhosis by ultrasonic velocity matching and MR diffusion imaging, and the dynamic monitoring of liver fibrosis by the regional velocity index and ADC value even helpful.

Objective The aim of this study was to investigate the therapeutic effect of isoglycyrrhizic acid magnesium in the treatment of patients with severe chronic hepatitis B (CHB) and the changes of peripheral blood regulatory T lymphocytes (Treg) and helper T cell 17 (Th17). Methods 80 patients with CHB of severe degree in our hospital from October 2017 through September 2018, and were divided into observation (n = 50) and control group (n = 30). They were given liver protection and antiviral treatment, and those in the observation group were treated withisoglycyrrhizic acid magnesium at base of treatment in the control. The regimen lasted for 30 days. Results At the end of 30 days of treatment, serum AST in the observation group was (124.2±10.2) U/L, significantly lower than [(179.3±13.5) U/L, P<0.05], serum ALT was (105.1±10.8) U/L, significantly lower than [(135.6±14.8) U/L),P<0.05], serum bilirubin level was (34.8±4.8)μmol/L, significantly lower than [(45.0±5.2)μmol/L,P<0.05] in the control; serum TNF-α in the observation group was (10.2±2.8) ng/L, which was significantly lower than [(13.5±2.5) ng /L, P<0.05], and the IL-4 was (49.1±7.2) ng/L, significantly lower than [(62.2±6.2) ng/L, P<0.05], serum IL-10 was (13.6±2.8) ng / L, significantly lower than [(19.3±3.2) ng/L,P<0.05] ], while serum IL-2 was (168.2±15.8) ng/L, which was significantly higher than [(142.2±14.0) ng/L,P<0.05] in the control; in the observation group, the percentage of peripheral blood Treg cells were (3.1±0.4)%, which was significantly lower than [(5.9±0.5)%,P <0.05], and the percentage of Th17 cells was (3.2±0.4)%, which was significantly lower than [( 4.9±0.5)%, P<0.05], and the ratio of Treg / Th17 cells was (0.9±0.1)%, significantly lower than [(1.2±0.3)%, P<0.05] in the control; the peripheral blood CD4⁺ cells in the observation group was (42.2±4.3)%, significantly higher than [(38.2±3.9)%, P<0.05], the CD8 ⁺ was (21.2±2.9)%, significantly lower than [(26.2±2.2)%, P<0.05], and the CD4 ⁺ / CD8 ⁺ cell ratio was (1.8±0.2), significantly higher than [(1.6±0.5), P<0.05] in the control; 90.0% of patients in the observation group improved, which was significantly higher than 70.0% in the control group (P<0.05). Conclusion The application of isoglycyrrhizic acid magnesium in patients with severe chronic hepatitis B has obvious curative effects, which might promote liver function recovery and correct immune dysfunction.

Objective The aim of this study was to investigate the clinical application of transient elastography (TE) and portal hemodynamic parameters in the diagnosis of liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods 98 patients with CHB were admitted to our hospital between February 2016 and September 2019, and liver biopsies were performed in all the patients. The liver stiffness measurement (LSM) was detected by TE, and the diameter of portal vein (PVD), the maximum velocity of portal vein (Vmax) and mean velocity of portal vein (Vmean) were obtained by sonography. The multivariate Logistic analysis was conducted for the influencing factors of LF, and the diagnostic efficacy was evaluated by AUROC. Results Out of 98 patients with CHB, the liver histopathological examination showed that LF F0 in 6, F1 in 22, F2 in 34, F3 in 28 and F4 in 8 patients; the LSM, PVD, Vmax and Vmean in patients with liver cirrhosis were (28.6±7.8)kPa, (1.4±0.4)cm, (27.4±2.5)cm/s and (22.8±3.1)cm/s, significantly different as compared to[(6.1±0.4)kPa, (1.0±0.2)cm, (33.8±1.4)cm/s and (28.5±1.4)cm/s, respectively, P<0.05] in patients with F1; the LSM, PVD, Vmax and Vmean in 70 patients with significant LF (>F2 stage) were (14.2±3.8)kPa, (1.4±0.4)cm, (29.1±2.1)cm/s and (24.1±2.1)cm/s, significantly different as compared to [(5.9±0.4)kPa, (1.0±0.2)cm, (36.8±1.5)cm/s and (30.5±1.4)cm/s, respectively, P<0.05] in 28 patients without significant LF (less than or equal to F1 stage); the Logistic regression analysis demonstrated that the LSM and PVD were the independent predicting factors for significant LF(P<0.05), and when LSM equal to 8.4 kPa was set as the cut-off-value, its diagnostic AUC was 0.84(95%CI :0.80-0.89), the sensitivity (Se) was 82%(95%CI:76%-85%) and the specificity (Sp) was 89%(95%CI:81%-93%), and as the PVD equal to 1.4 cm was set as the cut-off-value, its AUC was 0.83(95%CI :0.78-0.89), the Se was 81%(95%CI:75%-86%) and the Sp was 90%(95%CI:85%-94%). Conclusion The usefulness of LSM and PVD in non-invasively diagnosing LF in patients with CHB is feasible and efficacious, which warrants further clinical investigation.

Objective The aim of this study was to investigate the changes of ratio of aspartate aminotransferase to platelet counts (APRI), based on fibrosis-four (FIB-4) and serum transforming growth factor-β1 (TGF-β1) in patients with serum HBeAg negative chronic hepatitis B (CHB). Methods 78 patients with serum HBeAg-negative CHB and 78 healthy persons were enrolled in our hospital from January 2018 through May 2019, and the APRI, FIB-4 and serum TGF-β1 levels were detected or calculated. The liver biopsies were performed in all patients with CHB. Results The APRI score in patients with CHB was (0.9±0.4), which was significantly higher than that in the healthy group [(0.3±0.1), P<0.05] , the FIB-4 score was (1.4±0.4), significantly higher than [(0.5±0.2), P <0.05] in the healthy persons, and serum TGF-β1 level in patients with CHB was (14.5±5.3) ng / ml, which was significantly higher than [(7.4±3.5), P< 0.05] ng / ml in healthy persons; the APRI score in 33 patients with hepatic F0-1 fibrosis was (0.5±0.2), significantly lower than [(1.0±0.3),P<0.05] in 24 patients with F2, significantly lower than [1.3.±0.5), P<0.05】 in 12 patients with F3, and also significantly lower than [(1.8±1.6), P <0.05] in 9 patients with F4; the FIB-4 score in patients with F0-1 was (0.9±0.3), significantly lower than [(1.5±0.4), P < 0.05] in patients with F2, significantly lower than [(1.9±0.4), P <0.05] in patients with F3, and also significantly lower than [(3.2±0.6), P <0.05] in patients with F4; the serum TGF-β1 level in patients with F0-1 was (9.7±3.6) ng / ml, which was significantly lower [(10.5±4.4) ng / ml, P<0.05] in patients with F2, significantly lower than [(15.8±5.9) ng / ml, P<0.05] in patients with F3, and also significantly lower than [(19.5±6.2) ng / ml, P<0.05] in patients with F4. Conclusion The APRI and FIB-4 scores as well as serum TGF-β1 levels in serum HBeAg-negative patients with CHB increase greatly, which might help improve the diagnostic accuracy of liver fibrosis in this setting.

Objective The aim of this study was to compare the efficacy of telbivudine (LdT) and tenofovir disoproxil fumarate (TDF) in blocking hepatitis B viral transmission from mother to infant in pregnant women with high serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) loads. Methods 85 pregnant female HBV carriers with serum HBV DNA >1×10⁶ IU/mL were recruited in this study, and randomly divided into two groups, receiving LdT (n=43) or TDF (n=42) at gestational 28 weeks. The antiviral regimen lasted to the delivery. Serum HBV DNA and/or HBsAg positive were defined as HBV infection. Results At the delivery, serum HBV DNA load and HBeAg level in LdT-treated women were (2.9±0.6)lg IU/mL and (939.5±286.6)S/CO, both not significantly different compared to 【(3.1±0.7)lg IU/mL and (940.7±285.6)S/CO, respectively, P>0.05】 in TDF-treated women, and serum HBsAg, ALT and AST levels in the two groups were not much different (P>0.05); in LdT group, the infant's gestational age was (39.4±1.2)w, the height was (50.9±2.8)cm, the head circumference was(33.8±1.3)cm, the body mass was (3087.9±471.5)g and the Apgar score at one minute was(9.5±0.4), all not significantly different compared to【(39.6±1.1)w, (51.2±3.1)cm, (33.9±1.5)cm, (3112.9±464.9)g and (9.6±0.6), respectively, P>0.05】 in TDF group; the infant's HBV infection was 2.3% vs. 2.4% in the two groups (P>0.05). Conclusion Both LdT and TDF could be orally given to pregnant women with high serum HBV DNA loads at gestation of greater than 28 weeks to block mother-to-child HBV transmission, and worth further clinical investigation.

Objective The aim of this study was to explore the diagnostic diagnostic values of plasma Golgi protein 73 (GP73) and liver stiffness measurement (LSM) combination for liver fibrosis in patients with hepatitis B and C. Methods 46 patients with hepatitis B, 98 patients with hepatitis C, 17 patients with hepatitis B liver cirrhosis and 35 patients with hepatitis B liver cirrhosis as well as 56 healthy persons were enrolled in our hospital between June 2015 and January 2019, and plasma GP73 levels were detected by ELISA and LSM was obtained by Fibrotouch. Liver biopsies were performed in all the patients. The diagnostic efficacy was evaluated by area under ROC. Results Out of our series, the histopathological examination showed that liver fibrosis staging (S)1 in 45 (23.0%), S₂ in 50 (25.5%), S₃ in 49 (25.0%) and S₄ in 52 patients(26.5%), with ≥S₂ in 151 (77.0%) and ≥S₃ in 101 (51.5%); plasma GP73 levels in patients with S₁, S₂, S₃ and S₄ were (118.1±30.6) ng/ml, (135.8±39.7) ng/ml, (175.8±54.8) ng/ml and (228.7±74.6)ng/ml, and LSM were (6.1±1.8) kpa, (10.1±2.2) kpa, (15.3±4.5) kpa and (23.0±9.4) kpa, respectively, all significantly higher than (94.0±19.4) ng/ml and (5.4±2.0 ) kpa (P＜0.05) in healthy persons; the cut-off-value of plasma GP73 in diagnosing liver fibrosis ≥S₂, ≥S₃ and equal to S₄ were 127.7 ng/ml, 142.5 ng/ml and 155.6 ng/ml, and that of LSM were 8.8 kPa, 12.6 kPa and 17.9 kPa, and the diagnostic area under ROC of the two combination were 0.917(95% CI:0.875-0.948), 0.954(95% CI:0.920-0.977) and 0.950(95% CI:0.914-0.973), with the sensitivity of 71.5%, 86.1% and 88.5%, the specificity of 94.6%, 95.1% and 89.1%, and accuracy of 96.8%, 92.3% and 90.7%, respectively. Conclusion The application of plasma GP73 level and LSM combination in predicting liver fibrosis in patients with chronic hepatitis B and hepatitis C is feasible and simple, which warrants further investigation.

Objective To investigate the dynamic changes of serum anti-HEV IgM, IgG and HEV RNA in patients with acute hepatitis E (AHE). Methord Serum anti-HEV IgM, IgG and HEV RNA loads were detected in a consecutive 217 patient with AHE, who were admitted to our Hospital between January 2016 and March 2018. Results At presentation,serum anti-HEV IgM, anti-HEV IgG and HEV RNA positive in 31 cases(14.3%), anti-HEV IgM and IgG positive in 99 cases (45.5%), anti-HEV IgM positive in 8 cases (3.7%), anti-HEV IgG positive in 72 cases (33.2%), anti-HEV IgM and HEV RNA positive in 3 cases (1.5%), anti-HEV IgG and HEV RNA positive in 2 cases (0.9%), and anti-HEV IgM, IgG and HEV RNA negative in 2 cases(0.9%); in 75 patients with second detection, the results showed that serum anti-HEV IgG positive increased; in 138 patients with accurate onset of the disease, serum HEV RNA positive at week one, two, three, four and after four were 49.0%(25/51), 10.2%(6/59), 3.1%(1/32), 4.0%(1/25) and 0.0%(0/0); serum anti-HEV IgM positive were 70.6%(36/51), 69.5%(41/59), 65.6%(21/32), 48%(12/25) and 56.5%(13/23); serum anti-HEV IgG positive were 90.2%(46/51), 88.1%(52/59), 96.9%(31/32), 100%(25/25) and 100.0%(23/23). Conclusion Serum anti-HEV IgM, IgG and HEV RNA changes regularly in patients with AHE, which might help clinicians to make decisions for diagnosis and management.

Objective The aim of this study was to evaluate the clinical application of FibroTouch (FT) in combination with abdominal color ultrasound and computed tomography (CT) in diagnosis of individuals with nonalcoholic fatty liver disease in plateau regions. Methods A total of 343 persons with nonalcoholic fatty liver disease (NAFLD) were enrolled in the Department of Gastroenterology in the Qinghai Provincial People's Hospital between August 2018 and May 2019. The NAFLD was diagnosed by the examination of FT, abdominal color ultrasound, or CT. The diagnostic sensitivity, consistency, and diagnosis rate of FT relative to ultrasound or CT examination were analyzed by AUROC and Kappa value. Results The diagnosed rate of NAFLD by FT, ultrasound and CT examination were 63.9%, 40.2% and 26.2%, respectively, in our series; the diagnosis sensitivity and specificity of FT relative to ultrasoundex amination were 82.6% and 48.8% (AUROC=0.657, 95% CI: 0.610-0.704), and those relative to CT examination were 88.9% and 45.1% (AUROC=0.670, 95% CI: 0.624-0.715); the diagnostic results of FT had a lower consistency with both ultrasound or CT diagnosis by 62.4% (Kappa coefficient = 0.29) and 56.6% (Kappa coefficient = 0.23) ,respectively; the diagnostic rates of FT, ultrasound and CT examination were 88.7%, 55.9% and 36.3%, respectively; the diagnostic rates were raised to 98.4% and 92.7 when the FT combined with ultrasound examination or CT examination, respectively. Conclusions There is a lower consistency between FT and ultrasound or CT examination in diagnosis of NAFLD, while the diagnostic rate of NAFLD could be improved by FT combined with ultrasound or CT examination in persons in plateau regions.

Objective The aim of this study was to analyze Liganlong, a herbal conpound, and magnesium isoglycyrrhizate combination how to mitigates liver injury in patients with autoimmune hepatitis (AIH). Methods 122 patients with AIH were admitted to Department of Infectious Diseases and Gastroenterology in our hospital between July 2017 and May 2019, and were divided into control group and observation group by computer-generated randomized numbers, with 61 cases in each. The patients in the control group were treated by intravenous infusion of magnesium isoglycyrrhizinate and those in the observation group were treated with Liganlong tablets orally at the basis of medicine in the control group. The regimen in both groups lasted for 3 months. Serum chemotactic factor (CF) and immunoglobulin (Ig) levels were detected. Results At the end of treatment, serum alanine aminotransferase (ALT) level in the observation group was (46.3±13.7) U/L, significantly lower than [(82.5±14.2) U/L, P<0.05] and serum aspartate aminotransferase (AST) level was (45.5±14.3) U/L, significantly lower than [(66.7±16.8) U/L, P<0.05] in the control group; serum CF-8 level was (10.6±2.1)pg/mL, significantly lower than 【(15.8±3.3)pg/mL, P<0.05】, serum CF-2 level was (13.5±1.0)pg/mL, significantly lower than 【(19.0±1.3)pg/mL, P<0.05】, and serum CF-9 level was (12.1±1.7)pg/mL, significantly lower than 【(15.8±1.4)pg/mL, P<0.05】; serum IgG level was (1313.1±191.0)mg/L, significantly lower than 【(1816.4±311.6)mg/L, P<0.05】, serum IgM level was (506.2±151.3)mg/L, significantly lower than 【(814.1±225.1)mg/L, P<0.05】,and serum IgA level was (509.1±128.6)mg/L, significantly lower than 【(749.7±231.9)mg/L, P<0.05】 in the control; during the treatment, the incidence of side effects in the combination group was 18.0%, not significantly different as compared to 4.9% in the control group (P>0.05). Conclusion The steroid free treatment, e.g. Liganlong, a herbal medicine, and magnesium isoglycyrrhizinate combination, in patients with autoimmune hepatitis is a real viable option to obtain remission, that might be related to the inhibition of humoral immunity, reduction of serum CF-8 , CF-9 and CF-2 levels and obviously improvement of liver functions.

Objective The aim of this study was to investigate the changes of serum chemokines and golgi glycoprotein 73 (GP73) levels in patients with autoimmune hepatitis (AIH) and their clinical significance. Methods 46 patients with AIH and 46 healthy persons were recruited in our hospital between March 2018 and March 2019, and liver biopsies were performed in patients with AIH. The histopathological activities were divided into mild, moderate and severe degrees. Serum chemokine C-C-receptor 6 and 20 (CCR6 and CCL20), chemmokine C-C-ligand 10 (CXCL10) and GP73 levels were detected by ELISA. Results Serum CCR6, CCL20, CXCL10 and GP73 levels in patients with AIH were (112.4±59.3)pg/mL, (186.5±71.8)pg/mL, (81.5±42.0)pg/mL and (171.4±62.5)ng/mL, significantly higher than 【(75.8±32.6)pg/mL,(123.7±42.2)pg/mL, (53.9±28.1)pg/mL and (83.1±35.2)ng/mL, respectively, P<0.05】 in healthy persons; serum CCR6, CCL20, CXCL10 and GP73 levels in 10 patients with severe AIH were (174.2±81.4)pg/mL, (271.5±99.7)pg/mL, (162.7±83.1) pg/mL and (278.3±91.5)ng/mL, all much higher than 【(124.5±55.3)pg/mL,(198.6±66.9)pg/mL,(88.4±46.8)pg/mL and (186.2±75.8)ng/mL, respectively, P<0.05】 in 14 patients with moderate AIH or 【(83.5±34.5)pg/mL, (155.6±51.0)pg/mL,(42.6±22.7)pg/mL and (123.9±58.9)ng/mL, respectively, P<0.05 in 22 patients with mild AIH; serum CCR6, CCL20, CXCL10 and GP73 levels in 26 patients with hepatic G3-4 were (154.5±28.1)pg/mL, (201.6±56.3)pg/mL, (98.4±56.1)pg/mL and (196.2±59.78)ng/mL, all significantly higher than 【(73.5±34.8)pg/mL, (135.6±41.7)pg/mL, (62.5±20.1)pg/mL and (93.9±33.9)ng/mL, respectively, P<0.05】 in 20 patients with hepatic G1-2. Conclusion Serum CCR6, CCL20, CXCL10, and GP73 levels elevates greatly in patients with autoimmune hepatitis, and as the disease deteriorate, they increase obviously. The detection the serum parameters might monitor the illness progress, which needs multi-central investigation.

Objective The aim of this study was to compare the clinical features of patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and AIH/PBC overlap syndrome (AIH/PBC OS). Methods 92 patients with autoimmune liver diseases were admitted to the Third People's Hospital, Nantong city between December 2017 and February 2019, including AIH in 35, PBC in 30 and AIH/PBC OS in 27. The clinical data were compared. Results The ages, gender, body mass index and disease periods in patients with AIH, PBC and AIH/PBC were not significantly different(P>0.05); the incidences of clinical symptoms such as fatigue, abdominal distension, anorexia, fever and pruritus in the three groups were not much different(P>0.05); the jaundice was more common and higher serum ALP and GGT in patients with PBC and in with AIH/PBC OS, while the patients with AIH had higher serum ALT and AST levels (P<0.05); the TT was significantly longer in patients with AIH than in patients with PBC or AIH/PBC OS (P<0.05); the blodd Hb level in patients with AIH was significantly lower than in other two groups (P<0.05); the prevalence of serum ASMA in patients with AIH was 14.3%, significantly higher than 0.0% and 0.0% in other two groups(P<0.05), the positivity rates of AMA/AMA-M2 in patients with PBC and with AIH/PBC OS were 93.3% and 92.6%, while that in patients with AIH was 0.0%(P<0.05); serum immunoglobulin levels and the coincidence of hyperthyroidism, SLE, Sjogren's syndrome, rheumatoid arthritis, type two diabetes mellitus and chronic glomerulonephritis in the three groups were not significantly different(P>0.05). Conclusion The patients with AIH, PBC and AIH/PBC OS have sometimes similar clinical symptoms and signs, but there are obvious differences in biochemical and autoimmune antibodies, which might help the clinicians to deal with autoimmune liver diseases appropriately.

Objective The purpose of this study was to investigate the efficacy of continuous renal replacement therapy (CRRT) and plasma exchange (PE) combination in the treatment of patients with acute-on-chronic hepatitis B liver failure (ACLF) complicated by acute kidney injury (AKI). Methods 65 ACLF patients caused by hepatitis B viral infection and AKI were treated in ICU of our hospital between October 2016 and November 2019, and 35 cases received CRRT and PE combination and 30 received PE alone at base of conventional supporting management. The estimated glomerular filtration rate (eGFR), creatinine clearance rate (Ccr) and model for end-stage liver disease-Na (MELD-Na) were calculated. Results The survival rate in combination-treated group at day 90 was 54.3%, significantly higher than 23.3% in the PE-treated group (P<0.05); at the end of 90 day treatment, serum bilirubin level in 19 survivals in CRRT and PE-treated group was (28.8±11.1) μmol/L, much lower than 【(39.4±13.0) μmol/L, P<0.05】 in 7 patients in PE-treated group; at the end of day 28, the eGFR in 25 survivals in CRRT and PE combination-treated group was (79.4±24.7) mL/min/1.73 m², significantly higher than (65.75±16.1)mL/min/1.73 m², P<0.05】, the Ccr was (77.3±25.7)mL/min, much higher than 【(63.4±20.1)mL/min, P<0.05】, and the MELD-Na score was (22.4±4.5), significantly lower than 【(29.5±4.1)%, P<0.05】 in 16 survivals in PE-treated group, while the three parameters above mentioned in the survivals of the two groups at day 90 were not significantly different (P>0.05). Conclusion The application of CRRT and PE in the treatment of patients with ACLF caused byhepatitis B viral infection and complicated by AKI could reduce the short-term mortality, which might protect the liver and kidney functions and warrants further multi-central clinical trials.

Objective The aim of this study was to investigate the value of total liver volume (TLV)/spleen volume (SV) ratio by multislice CT calculation in diagnosis ofpatients with liver cirrhosis (LC). Methods 138 cirrhotic patients and 130 patients with benign liver diseases or healthy persons were admitted to our hospital between October 2016 and October 2019, and all underwent dynamic contrast-enhanced multi-slice spiral CT scan. The TLV, right liver volume (RV), left inner lobe volume(LMV), left outer lobe volume (LLV), cauda lobe volume (CV), SV as well as TLV/RV ratio, TLV/LMV ratio, TLV/LLV ratio, TLV/CV ratio and TLV/SV ratio were calculated by software. Results The TLV, RV and LMV of liver in patients with LC were (1078.2±315.7) cm³, (543.8±186.5) cm³ and (163.6±73.7) cm³, significantly smaller than [(1470.4±199.7) cm³, (933.3±174.1) cm³ and (216.2±40.1) cm³, respectively, P<0.05], while the LLV and SV were (327.8±121.9) cm³ and (863.4±396.8) cm³, both significantly larger than [(275.9±65.7) cm³ and (256.3±81.7) cm³, respectively,P<0.05] in the control; the TLV / RV ratio in patients with LC was 2.0±0.9, significantly higher than [1.6±0.7, P<0.05], while the TLV / LLV ratio, TLV / CV ratio and TLV / SV ratio were (3.3±1.5), (25.3±12.4) and (1.3±0.6), all significantly lower than [(5.3±2.5),( 32.8±16.1) and (5.7±2.4), respectively, P<0.05] in the control; there were no significant differences in CV and TLV/LMV ratio between the two groups (P>0.05). Conclusion The calculation of TLV/SV by multislice spiral CT scan might help diagnose LC in clinical practice.

Objective The aim of this study was to investigate the efficacy and safety of direct acting antiviral agents (DAAs) in the treatment of patients with chronic hepatitis C viral infection-induced liver cirrhosis (CHC-C). Methods 30 patients with CHC-C received DAAs treatment in our hospital between March 2016 and October 2017, and the genotype of hepatitis C virus was 1b type in all patients. The patients with CHC-C were divided into three groups, receiving sophibavi and ribavirin in group A, receiving sophibavi, repaavi plus ribavirin in group B, and took suopavir, daclatasvir and ribavirin in group C, with 10 cases in each group, and all patients were treated for 12 weeks. Serum HCV RNA loads were measured by reverse transcription polymerase chain reaction (RT-PCR), serum level of alanine aminotransferase (ALT), glutaminase (AST), total bilirubin (TBIL), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) were measured. The extremely rapid virologic response(RVR), early virologic response(EVR) , end of treatment virologic response(ETVR) and sustained virologic response were compared among the groups. Results The RVR and ETVR in group B and in group C were 100%, all significantly higher than 40% and 50% in group A(P<0.05); at the end of 12 week DAAs treatment, serum ALT levels in group A, group B and group C were (24.2±6.7)IU/L, (22.3±5.6)IU/L and (25.3±4.6)IU/L, serum AST levels were (23.2±8.1)IU/L, (24.6±3.8)IU/L and (28.4±4.8)IU/L, not significantly different among them(P>0.05); serum albumin and renal function index in the three groups were not significantly different (P>0.05), serum creatine kinase levels in the three groups were (63.3±11.8)U/L, (68.5±8.9)U/L and (62.1±10.2) U/L, not significantly different (P>0.05); there were 7 patients reporting nausea, and fatigue in one, headache in one and palpitation in one in group A, nausea in four, fatigue in three, headache in one, palpitation in one and rash in one in group B, and nausea in five, fatigue in two, headache in one, palpitation in one and rash in one in group C. Conclusion DAAs is efficacious and safe in the treatment of patients with CHC-C with HCV genotype 1b infection.

Objective Microecological preparation is always applied to treat patients with liver cirrhosis complicated by spontaneous bacterial peritonitis (SBP), and we conduct a clinical trial to administer the microecological agent for the treatment of patients with SBP, and observe the changes of ascites, biochemical indexes, urinary lactulose / mannitol (L/M) ratio, serum cytokines and endotoxin. Methods 68 patients with liver cirrhosis complicated by SBP were recruited in this study between December 2014 and June 2018,and were randomly divided into control (n=34) and observation groups (n=34). The patients in the control were treated with quinolones and third generation of cephalosporins for four weeks, and the patients in the observation group were treated with microecological preparations (Peifeikang capsule) at the basis of the treatment regimen in the control group for four weeks. Urine lactulose / mannitol were detected by high performance liquid chromatography, serumprocalcitonin (PCT), IL-10, TNF-α and endotoxin levels were also determined. Results At the end of four week treatment, the abdominal circumference, 24-hour urine volume, leukocyte counts in ascites and serum PCT levels in the observation group were(67.4±10.2)cm,(1685.4±305.6)ml, (156.2±92.0)×10⁶/L and (0.45±0.15)ng/ml, all significantly different compared to 【(75.6±11.3)cm, (1450.3±326.8)ml, (360.8±110.5)×10⁶/L and (1.24±0.60)ng/ml, respectively, P<0.05】 in the control; serum ALT, AST and bilirubin levels in the observation group were (40.6±18.0)U/L,(45.8±20.4)U/L and (45.2±10.8)μmol/L, all significantly lower than 【(62.5±15.4)U/L,(59.8±21.5)U/L and (54.0±11.5)μmol/L, respectively, P<0.05】 in the control; the urine L/M ratio, serum IL-10, TNF-α and endotoxin levels were (0.07±0.01), (32.6±5.4)ng/L, (29.8±7.0)ng/L and (0.33±0.10)EU/ml, all significantly different compared to 【(0.09±0.01), (27.1±5.0)ng/L,(38.9±8.5)ng/L and (0.46±0.13)EU/ml, respectively, P<0.05】 in the control. Conclusion The application of microecological agents in assisting treatment of patients with liver cirrhosis complicated by SBP could effectively improve ascites subsidizes, protect liver functions, inhibit the expression of inflammatory cytokines, reduce intestinal endotoxin and regulate intestinal flora.

Objective The aim of this study was to investigate the clinical efficacy of endoscopic tissue gel injection and sclerotherapy-ligation in the treatment of patients with esophageal and gastric varices (EGV). Methods 76 cirrhotic patients with EGV were recruited in our hospital from July 2017 through February 2019, and were randomly divided into control group (n=38) and combination group (n=38). The patients in the control group were treated with endoscopic ligation and those in the combination group were treated with endoscopic tissue glue injection and sclerotherapy-ligation combination. All patients were followed-up for 6 months. Results At the end of 6-month follow-up, 2 cases (5.3%) lost and 5 cases (13.2%) died in the control group, 3 cases (7.9%) lost and 2 cases (5.3%) died in the combination, and the total efficient rates were 71.0% in the control to 81.8% in the combination (P<0.05); the incidence of postoperative rebleeding, obstruction and esophageal stricture in the combination group was 24.2%, 18.2% and 15.2%, significantly lower than 41.9%, 35.5% and 25.8% (P<0.05) in the control. Conclusion Endoscopic tissue gel injection combined with sclerotherapy-ligation is efficacious in the treatment of cirrhotic patients with esophagogastric varices to prevent rebleeding with low incidence of adverse reactions, which worth further clinical investigation.

Objective To investigate the value of CT-detected portal parameters in the diagnosis ofsignificant clinical portal hypertension (SCPH) and predictingesophageal and gastric variceal bleeding in patients with hepatitis B cirrhosis. Methods 62 patients with hepatitis B liver cirrhosis were admitted to our hospital from May 2016 to November 2019, and all patients received CT examination having relevant portal parameters recorded. The hepatic vein pressure gradient (HVPG) was detected. The receiver operating characteristic curve (ROC) were applied to analyze CT-related parameters to diagnose SCPH when the HVPG was acted as the gold standard, and to predict bleeding of esophageal and gastric varices. Results There were 27 patients having SCPH in our series; the total liver volume in this 27 patient with SCPH was (1015.7±162.8)cm³, significantly smaller than [(1174.2±204.5)cm³,P<0.05] in 35 patients without SCPH, the spleen volume was (852.±264.3) cm³, significantly larger than [(593.9±303.4) cm³, P<0.05],the width of portal vein was (1.2±0.2)cm, significantly wider than [(1.0±0.3) cm³, P<0.05)], and the width of splenic vein was (1.1±0.2) cm, significantly wider than [(0.9±0.2)cm, P<0.05] in patients without SCPH; the ROC analysis showed that the spleen volume (AUC=0.742,the sensitivity = 0.778), the whole liver volume (AUC = 0.802, sensitivity = 0.809), the portal vein width (AUC = 0.777, sensitivity = 0.815) and spleen vein width (AUC = 0.708, sensitivity = 0.815) had good value in the diagnosis of SCPH (P<0.05), and that the spleen volume (AUC = 0.727, sensitivity = 0.882), the whole liver volume (AUC = 0.686, sensitivity = 0.765), the portal vein width (AUC = 0.684, sensitivity = 0.824) and the spleen vein width (AUC = 0.787, sensitivity = 0.771) had higher sensitivity to forecast the esophageal and gastric variceal bleeding (P<0.05). Conclusion The portal parameters by CT scan in patients with hepatitis B cirrhosis are closely related to HVPG, and they might be helpful for the diagnosis of SCPH and judgement of esophageal and gastric variceal bleeding in clinical practice.

Objective The purpose of this study was to investigate the efficacy of terlipressin and somatostatin combination in the treatment of cirrhotic patients with upper gastrointestinal bleeding, and serum glucagon (GCG) and nitric oxide (NO) level changes. Methods 104 hepatitis B cirrhotic patients with upper gastrointestinal bleeding were enrolled in our hospital and were randomly divided into observation (n=52) and control group (n=52). The patients in the control group were treated with somatostatin, and those in the observation group were treated with terlipressin based on somatostatin. The regimen lasted for3 days. Serum high-sensitivity C-reactive protein (hs-CRP), cortisol (COR), glucagon (GCG) and nitric oxide (NO) were assayed. Results The stopping time of hematemesis, stable blood pressure and hemostatic time in the combination group were (5.2±2.1)h, (11.9±3.1)h and (21.9±7.1)h, significantly shorter than 【(8.5±2.3)h, (15.5±5.3)h and (30.5±5.3)h, respectively, P<0.05】 in the control, and the the effective rate in the former was 94.2%, much higher than 78.9%(P<0.05) in the latter; after treatment, the blood hemoglobin was (107.3±19.4) g/L, much higher than [(98.6±17.9) g/L, P<0.05], the hematocrit was (37.6±5.8)%, much higher than【(29.4±6.5)%, P<0.05】 and platelet counts was (101.4±19.2)×10⁹/L, significantly higher than 【(92.8±18.4)×10⁹/L, P<0.05】 in the control; the portal vein blood flow was (481.3±91.7) mL/min, much slower than [(608.6±98.5) mL/min, P<0.05], the splenic vein blood flow was (231.4±44.2) mL/min, much slower than [(302.8±52.4) mL/min, P<0.05], the diameter of portal vein was(12.6±1.1)mm, significantly lower than 【(14.7±1.0)mm, P<0.05】 and the splenic vein diameter was (9.2±0.8)mm, much lower than 【(12.6±0.9)mm, P<0.05】 in the control; serum hs-CRP level was (6.5±1.1) μg/L, much lower than 【(12.3±3.2)μg/L, P<0.05】, serum COR level was (281.2±12.6)μg/L, much lower than 【(318.7±14.9)g/L, P<0.05】 and serum GCG level was (149.8±17.4)ng/L, much lower than 【(182.4±19.3)ng/L, P<0.05】, while serum NO level was (119.4±10.7)μmol/L, significantly higher than 【(96.9±12.6)μmol/L, P<0.05】 in the control. Conclusion The successful hemostasis is obtained by administration of terlipressin and somatostatin combination in cirrhotic patients with variceal hemorrhage, which might reduce blood GCG and elevate NO levels.

Objective The aim of this study was to observe the efficacy of terlipressin in combination with albumin infusion for patients with cirrhosis complicated by type Ⅱ hepatorenal syndrome (HRS). Methods 60 patients with liver cirrhosis and type Ⅱ HRS were admitted to our hospital between July 2017 and May 2019, and were randomly divided into two groups, with 30 in each group. The patients in the control group were treated with intravenous albumin infusion, and those in the observation group were treated with intravenous terlipressin infusion at the basis of treatment in the control group for two weeks. Serum angiotensin Ⅱ (Ang Ⅱ), urine neutrophils enzyme related lipid carrier protein gelatin (uNGAL), and urine kidney damage factor 1 (uKIM-1) were detected. Results At the end of two week treatment, the total effective rate in the observation group was 85.3%, significantly higher than that in the control group (63.3%, P<0.05); the 24 h urine volume in the observation group was (1256.7±530.5) mL, significantly higher than that in the control group [(824.9±384.4) mL, P<0.05], the body mass was (51.8±4.5) kg, significantly lower than in the control group [(57.6±4.8) kg, P<0.05], and the abdominal circumference was (88.2±5.8) cm, significantly lower than in the control group [(95.7±6.4) cm, P<0.05]; the urea nitrogen level in the observation group was (10.8±2.4) mmol/L, significantly lower than that in the control group [(14.7±3.2) mmol/L, P<0.05], the creatinine level was (139.7±14.4) mol/L, significantly lower than in the control group [(154.9±17.5) mol/L, P<0.05], and serum sodium level was (135.8±8.2) mmol/L, significantly higher than in the control group [(132.2±7.9) mmol/L, P<0.05]; serum Ang Ⅱ level was (14.6±1.5) pg/mL, significantly lower than in the control group [ (18.3±1.8) pg/mL, P<0.05], the uNGAL level was (1.0±0.4) g/L, significantly lower than in the control group [(1.2±0.2) g/L, P<0.05], and the level of ukim-1 was (3.8±0.4) g/L, significantly lower than that in the control group [(4.4±0.3) g/L, P<0.05]. Conclusion The combination of intravenous administration of terlipressin and albumin could significantly improve the glomerular filtration functions, increase urine volume, which might be related to the reduction of serum Ang Ⅱ, uNGAL, and uKIM-1 levels.

Objective To study the diagnostic value of three-dimensional reconstruction of blood vessels in differential diagnosis of patients with Budd-Chiari syndrome (BCS) and liver cirrhosis after hepatitis B infecton. Methods 28 patients with BCS and 46 patients with liver cirrhosis after hepatitis B viral infection were enrolled between March 2017 and March 2020, and All patients underwent three-dimensional reconstruction of blood vessels by CT imaging. The imaging features of three-dimensional reconstruction of blood vessels were recorded. The Logistic regression analysis was applied to explore the value of each sign in the diagnosis of BCS, and a regression equation was established. The receiver operating characteristic curve (ROC) was used to analyze the value of this regression equation in the diagnosis of BCS. Results The collateral opening of intrahepatic vein in patients with BCS was 82.1%, which was significantly higher than that in patients with cirrhosis(15.2%, P<0.05), the communication between azygos vein and ascending lumbar vein was 46.4%, which was significantly higher than that in cirrhosis group (10.9%, P<0.05), the filling defects of inferior vena cava and hepatic vein in BCS group were 85.7% and 92.9%, respectively, which were significantly higher than those in cirrhosis group (10.9% and 8.7%,P<0.05), the retroperitoneal varicosity in BCS group were 35.7%, which was significantly higher than that in cirrhosis group (10.9%,P<0.05), the caudate lobe enlargement in BCS group was 64.3%, which was significantly higher than that in cirrhosisgroup (6.5%,P<0.05), the map snow pattern enhancement was 82.1% in BCS group, which was significantly higher than in the cirrhosis group(6.5%,P<0.05), the uneven enhancement of portal phase in BCS group was 85.7%, which was significantly higher than that in cirrhosis group (13.0%,P<0.05); the multivariate Logistic analysis showed that the collateral opening of intrahepatic vein (95%CI=1.035-3.332,P=0.038), the communication between azygos vein and ascending lumbar vein (95%CI=1.203-2.296,P=0.002), the filling defect of inferior vena cava (95% CI=1.694-4.893,P=0.000),the filling defect of hepatic vein (95%CI=1.695-3.156,P=0.000),the caudate lobe enlargement (95%CI=1.012-1.901, P=0.042), and the uneven enhancement of portal phase (95%CI=1.234-2.916,P=0.004) were the independent indicator in the diagnosis of BCS; the regression equation was established,and the ROC analysis showed that the AUC of the regression equation we established in diagnosis of BCS was 0.888 (95%CI=0.812～0.965,P=0.000), which were highest among any other signs. Conclusion The three dimensional reconstruction of blood vessels by CT scan is helpful to distinguish between BCS and the hepatitis B liver cirrhosis, which might be used for early screening and diagnosis of patients with BCS.

Objective The aim of this study was to investigate the auxiliary assistance of MR venography (MRV) for digital subtraction angiography (DSA)-guided interventional therapy in the treatment of patients with Budd-Chiari syndrome(BCS). Methods 120 patients with BCS were admitted to our hospital between March 2014 and March 2019, and underwent 3.0 T MRV. All patients received interventional therapy under DSA guidance. Results The MRV showed 7.5% and 25.0% of the dangerous communicating branches and occlusive ends of inferior vena cava, significantly lower than 40.0% and 60.0% by DSA (P<0.05), and 95.0%, 80.0%, 75.0% and 52.5% of right, middle and left branches of hepatic vein, and accessory hepatic vein, respectively, all significantly higher than 40.0%, 35.0%, 30.0% and 17.5% by DSA (P<0.05), while there were no significant differences as for the demonstration of segment of inferior vena cava, stenosis, inferior vena cava occlusion, inferior vena cava membranous formation and thrombosis by the two methods (P>0.05); the interventional therapy was successful in 120 patients, for which, 21 cases (17.5%) by via femoral vein, 63 cases (52.5%) via right femoral veinand right internal jugular vein, 3 cases (2.5%) via percutaneous hepatic vein combined with internal jugular vein, and 33 cases (27.5%) via right internal jugular vein. Conclusion The MRV could clearly show the obstruction of blood vessels in patients with Budd-Chiari syndrome before interventional therapy, which might help the correct operation under DSA angiography in clinical practice.

Objective The aim of this study was to investigate the influencing factors of outcomes of patients with hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (MWA) by Milan criteria. Method 94 patients with HCC with hepatic solitary tumor≤5 cm were treated with ultrasound-guided MWA in our hospital between January 2013 and December 2016, and were all followed-up for 5 years. Independent risk factors for overall survival (OS) and progression-free survival (PFS) were analyzed. Result The cumulative overall survival rate in our series at 5 years were 64.9%, and the cumulative 1-year and 2-year tumor recurrence rates were 12.8% and 53.2%; the PFS in patients with tumor mass > 3 cm was significantly shorter than that in patients with tumor diameter≤3 cm (P = 0.005), and the OS in patients with PFS≤2 years was significantly shorter than that in patients with PFS> 2 years (48.0% vs. 84.1%, P < 0.001); multivariate Cox analysis showed that the tumor > 3 cm (HR=0.42,95%CI:0.21-0.83, P=0.011) was the independent risk factor for postoperative recurrence of HCC, and the leukocyte counts < 4.0×10⁹ /L ( HR=0.38, 95%CI:0.18-0.84,P=0.017) and PFS≤2 years (HR=0.24,but most patients with intrahepatic tumor recurrence remain eligible for repeated treatment and get a relatively good outcomes. 95%CI:0.10-0.56,P=0.001) were the independent risk factors for OS. Conclusion The patients with hepatic tumor > 3 cm by Milan criteria might have less PFS after MWA.

Objective To explore the short-term curative effect of transcatheter arterial chemoembolization (TACE) with ¹³¹I mentuximab perfusion in the treatment of patients with primary liver cancer (PLC) and influencing factors of prognosis. Methods Eighty-four patients with PLC were admitted to our hospital from August 2016 through December 2017, and were divided into control group and observation group, with 42 cases in each group. The patients with PLC in the control group were treated with TACE, and those in the observation received TACE and ¹³¹I mentuximab perfusion. All patients were followed-up for 12 months. The risk factors affecting prognosis were analyzed by multivariate Logistics regression analysis. Results At the end of three months, the remission rate and control rate in the observation group were 73.8% and 90.5%, significantly higher than 50.0% and 73.8%, respectively, in the control(P<0.05);the incidence of side effects was 28.6% in the observation group, not significantly different compared to 33.3% in the control group (P>0.05); serum alpha-fetoprotein level in the observation group was (418.7±67.3) ng/ml, much lower than [(504.7±71.5) ng/ml, P<0.05] in the control, and serum albumin level was (37.7±3.4) g/L, significantly higher than [(34.2±3.3) g/L, P<0.05] in the control; at the end of 12 month, seven patients(16.7%)in the observation died, while twelve patients (28.6%)in the control died (P<0.05); the multivariate Logistics regression analysis showed that the portal vein tumor thrombus, tumor diameter greater than 5 cm and advanced stage of TNM were the risk factors of poor prognosis(OR=2.354, P=0.027; OR=2.670, P=0.011; OR=3.071, P=0.004). Conclusion The short-term curative effect of TACE with ¹³¹I mentuximab perfusion in the treatment of patients with PLC is promising, and some factors such as portal vein tumor thrombus, large tumor diameter and advanced TNM staging might hint poor prognosis.

Objective The aim of this study was to observe the short-term efficacy of cyberknife stereotactic radiotherapy (CSR) and transcatheter arterial chemoembolization(TACE) as the first line treatment for patients with primary liver cancer (PLC). Methods 58 patients with PLC were recruited in this study between January 2016 and May 2019, and were randomly divided into two groups. 29 patients received TACE and other 29 patients underwent TACE and CSR. Serum vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP) and AFP were detected. Results The total effective rate in TACE and CSR combination group was 82.8%, significantly higher than 58.6% in TACE-treated group (P<0.05); after treatment, serum VEGF level in the combination-treated group was (200.4±20.6) pg/ml, significantly lower than 【(326.5±31.5)pg/ml, P<0.05】, serum MMP level was (30.16±28.9)ng/L, significantly lower than 【(74.2±7.5)ng/L, P<0.05】, and serum AFP level was (632.5±60.3)μg/L, significantly lower than 【794.6±71.8)μg/L, P<0.05】 in the TACE-treated group; serum alanine aminotransferase level was (48.4±2.7)U/L, significantly higher than 【(35.4±4.0)U/L, P<0.05】 in TACE-treated group; the incidence of side effects was 44.8%, not significantly different compared to 48.3% in TACE-treated group (P>0.05). Conclusion The TACE and cyberknife stereotactic radiotherapy in treatment of patients with PLC non suitable for surgery has a good short-term clinical efficacy, which needs further investigation.

Objective The aim of this study was to investigate the clinical application of MSCT and MRI dynamic enhanced scans in diagnosing patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) with high blood supply. Methods A total of 70 patients with primary liver cancer were admitted to our hospital between January 2018 and June 2019, and all underwent MSCT and MRI dynamic enhanced scans. The post-operational histopathological examination was performed as a gold diagnostic criterion. Results The post-operational histopathological examination showed 12 patients with ICC, and 58 patients with HCC in our series; the MSCT multi-phase enhancement demonstrated arterial phase enhancement, venous phase enhancement decline and even enhancement decline in delayed phase in 53 patients with HCC, and arterial phase enhancement, continuous portal phase and delayed phase enhancement in 7 lesions in 12 patients with ICC; the MRI multi-phase enhancement found in 58 patients with HCC having 39 lesions of fast-in and fast-out type enhancement, having 17 lesions of fast-in and slow-out, and having 2 lesions of slow-in and slow-out, and in 12 patients with ICC having 9 lesions of slow-in and slow-out type and having 3 lesions without significant enhancement in arterial and portal phases and with gradually enhancement in delayed phase; the MRI scan made a correct diagnosis of HCC in 56 patients (96.6%), not significantly different compared to in 53 cases (91.4%) by MSCT scan (P>0.05), while it found ICC in 9 patients (75.0%) with ICC, significantly higher than in 7 patients (58.3%) by CT scan (P<0.05). Conclusion There are imaging differences in patients with ICC and HCC with rich blood supply, and the MRI scan might improve diagnosing patients with ICC earlier, which warrants further clinical investigation.

Objective The aim of this study was to explore the value of three-dimensional CT reconstruction in evaluating theresectability of tumorsin patients withhilar cholangiocarcinoma. Methods 89 patients with hilar cholangiocarcinoma were admitted to our hospital from May 2016 through May 2019,and underwent surgical removal of tumors. Before operation, all the patients received three-dimensional reconstruction of conventional CT scan to determine Bismuth-Corlette classification, peripheral vascular involvement and lymph node metastasis. Results The post-operational histopathological examination showed that out the 89 patients, there wereBismuth-Corlette class Ⅰ in 13, class Ⅱ in 13, class Ⅲa in 11, class Ⅲb in 28 and class Ⅳ in 24, and the accuracy (Ac) of CT reconstruction was 93.3%; as to the efficacies of CT reconstruction in judging hepatic artery and portal vein involvement as wellaslymph node metastasis, the Kappa values were 0.7, 0.7 and 0.3, the sensitivities (Se) were 87.5%, 87.5% and 62.5%, the specificities (Sp) were 89.2%, 86.0% and 75.3%, the Acs were 88.8%, 86.5% and 73.0%, the positive predictive values (PPV) were 75.0%, 77.8% and 35.7%, and the negative predictive values (NPV) were 95.1%, 92.5% and90.2%,respectively; the Kappa was 0.7, the Se was 98.2%, the Sp was 65.6%, the Ac was 86.5%, the PPV was 83.6% and the NPV was 95.5% by CT reconstruction in evaluating theresectability of tumors. Conclusion The application of CT three-dimensional reconstruction before operation in patients withhilar cholangiocarcinoma could help display Bismuth-Corlette typing, peripheral vascular involvement and lymph node metastasis, which might be useful in judging theresectability of tumors.

Objective To investigate the clinical effects of ¹²⁵I seed implantation at base of biliary stenting for the treatment of patients with malignant obstructive jaundice(MOJ). Methods 96 MOJ patients were admitted to our hospital from June 2015 to October 2017, and 55 patients out of them in the control group underwent percutaneous transhepatic bile duct drainage (PTCD) followed by biliary stent implantation and 45 patients in the observation group underwent PTCD followed by biliary stent implantation and ¹²⁵I particle implantation. The liver function indexes,including total bilirubin (TBIL), serum alanine aminotransferase (ALT), and serum aspartate aminotransferase (AST) ] and serum tumor marker CA199 levels before and 1 month after operation, the recent clinical efficacy, survival and postoperative complications in the two groups were compared. Results The interventional operation in the 96 patients was all successful; there were no obvious bleeding, peritonitis, biliary tract perforation, enteritis, biliary tract infection, reduction of white blood cell counts, nausea, vomiting and other complications in the two groups after operation; one month after surgery, serum bilirubin levels in the observation group and in the control group were (32.6±19.2) μmol / Lvs. (107.8±20.2) μmol / L, serum direct bilirubin levels were (23.4±12.4) μmol / L vs (97.4±12.5) μmol / L, serum ALT levels were (30.4±16.5)U/L vs. (85.9±19.8)U/L, serum AST levels were (30.7±13.2)U/L vs. (71.4±18.9)U/L, and serum CA199 levels were (30.7±13.2)U/L vs. (71.4±18.9)U/L, with significant differences between the two groups (all P <0.05); the average postoperative biliary patency in the observation group was (6.4±3.8) months, which was significantly longer than that in the control group [(2.9±1.8) months, P <0.05]; the total effective rate in the observation group was 53.7%, which was significantly higher than that in the control group (30.9%, P <0.05); the median survival time in the observation group was 10.7 months, which was significantly longer than that in the control group (6.2 months, P＜0.05). Conclusion The combination of biliary stent and ¹²⁵I seed implantation is an alternative option for patients with MOJ, with the subsidence of jaundice, inhibition of tumor growth, which might prolong the survival time of patients.

Objective The purpose of this study was to investigate the gray-scale ultrasound(GSUS), Doppler US (CDFI) and contrast-enhanced ultrasound (CEUS) feature of hepatic epithelioid angiomyolipoma (EAML). Methods A retrospective analysis of 20patients with EAML proven by histopathological examination in our hospital was conducted. The clinical data, GSUS, CDFI, and CEUS werereviewed. Results All the 20 cases had a single hepatic lesion, with maximum tumor diameter of (49.23±10.3) mm; the GSUS showed 70.0% (14/20) of lesions were hypo-echoic,15.0% (3/20) hyper-echoic and 15.0% (3/20) mixed-echoic; 50.0% (10/20)of the lesions had striated or branching blood flow and 15.0%(3/20)showed ring-like or arc arterials on Doppler US; the resistance index (RI) was 0.46±0.34; all lesions showed hyperenhancement during arterial phase on CEUS, and 13 cases(86.6%)presenting uniform enhancement; there were 12 cases with high enhancement (80.0%), 2 cases (13.0%) withiso-enhancement and 1 cases(6.6%)with low enhancement in the portal vein phase; in the delayed period, 10 cases (66.6%) had high enhancement, 4 cases (26.6%) had iso-enhancement, and 1 cases (6.6%) had low enhancement. Conclusion The EAML ismainly characterized by hypoechoic, abundant blood flow with low RI, and hyperenhancement in arterial phase and hyper- or iso-enhancement in the portal phase.The combination of GSUS, CDFI and CEUS might improve the correct diagnosis of EAML in clinical practice.

Objective The aim of this study was to investigate the dynamic changes of thromboelastography (TEG) and coagulation function parameters before and after liver transplantation and its significance for guidance of blood transfusion. Methods 52 patients with benign and malignant liver diseases underwent liver transplantation between March 2018 and March 2020, and the TEG indexes, such as reaction time (R), clot formation time (k), angle (α), maximum amplitude (MA) and four items of coagulation functions such as prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT) and fibrinogen (FIB) were monitored in patients at pre-without liver, without liver and new liver stages. Results Out of our 52 recipients of liver transplantation, 17.3%, 86.5% and 75.0%(P<0.05) of them received blood transfusion at pre-without liver, without liver and new liver stage; the APTT in patients with blood transfusion at pre-without liver stage was(74.4±7.2) s, significantly longer than 【(66.9±8.1)s, P<0.05】 in patients without blood transfusion, the PT and TT in recipients with blood transfusion at new liver stage were(30.4±5.4)s and (30.2±3.6)s, significantly longer than 【(26.1±4.6)s and (27.0±4.2)s, P<0.05 in those without blood transfusion, while the APTT, PT, TT and Fib in patients with or without blood transfusion at without liver stage were not much different(P>0.05); the K value in patients with bloodtransfusion at without liver stage was (7.6±1.8)min, significantly longer than 【(6.0±2.0)min, P<0.05】 in those without blood transfusion, the R, K andα in patients with blood transfusion at without liver stage were(26.4±5.5)min, (15.3±2.8)min and (15.8±4.4)°, while they were(21.8±4.3)min, (12.0±3.9)min and (19.5±3.9)°, respectively,in those without blood transfusion, showing significantly different between the two groups(P<0.05); the α and MA in patients with blood transfusion at new liver stage were(20.3±4.1)° and (34.4±5.8)mm, significantly different compared to(23.8±3.5)° and (39.0±4.5)mm in patients without blood transfusion(P<0.05); the APTT in 20 patients with huge blood transfusion at pre-without liver stage was(77.3±6.8)s, significantly longer than【(70.4±7.9)s, P<0.05】 in 32 patients without huge blood transfusion, the K in patients with huge blood transfusion at pre-without liver stage was (8.0±1.7)min, significantly longer than 【(7.1±1.4)min, P<0.05】 in those without huge blood transfusion, the R in patients with huge blood transfusion at without liver stage was (29.3±5.2)min, significantly longer than 【(23.6±4.7)min, P<0.05】 in those without huge blood transfusion, the K in patients with huge blood transfusion atwithout liver stage was (16.8±3.1)min, much longer than【(13.7±2.8)min, P<0.05】in those without huge blood transfusion, the α at without liver stage was (15.2±3.6)°, significantly smaller than【(18.4±4.4)°, P<0.05】 in those without huge blood transfusion, the TT in patients with huge blood transfusion at new liver stage was(31.5±3.0)s, significantly longer than 【(28.2±3.3)s, P<0.05】 in those without huge blood transfusion, the MA at new liver stage was(32.8±5.5)mm, significantly shorter than 【(38.7±4.3)mm, P<0.05】 in those without huge blood transfusion, and theα at new liver stage was (19.8±3.7)°, significantly smaller than【(22.4±3.1)°, P<0.05】 in patients without huge blood transfusion. Conclusion The dynamic surveillance of four items of coagulation functions and TEG parameters are helpful to judge the coagulation function state andcould guide the clinicians for appropriate blood transfusion before and after liver transplantation, especially the dynamic monitoring of R and α values of TEG are helpful to predict the risk of massive blood transfusion during operation.

Objective The aim of this study was to investigate the efficacy of transhepatic artery embolization (TAE) in treatment of patients with hepatic hemangioma and serum glycylproline dipeptide aminopeptidase (GPDA), Golgi protein 73 (GP73) and β2-microglobulin (β2-MG) level changes. Methods 60 patients with hepatic hemangioma were treated in our hospital between January 2017 and January 2019, and 30 received TAE and another 30 underwent open hepatectomy. After operation, all patients were followed-up for six months. Serum GPDA, GP73, β2-MG, tumor necrosis factor-α (TNF-α), tumor-specific growth factor (TSGF) and alpha-fetoprotein (AFP) were assayed by ELISA. Results The operation time and postoperative hospital stay in TAE-treated patients were (84.7±21.9) min and (6.7±1.3) d, significantly shorter than [(126.8±60.5) min and (9.6±5.8) d, P<0.05], and bleeding during operation was (110.7 ± 13.5) mL, much less than [(315.5±17.8) mL, P<0.05] in those receiving open hepatectomy; 1 week after surgery, serum GPDA, GP73,β2-MG, TNF-α, TSGF and AFP levels in the interventional group were (62.6±9.8)U/L, (64.3±6.7)μg/L, (1.4±0.5)mg/L, (1.3±0.5)mg/L, (35.5±4.3)U/mL and (2.5±0.6)mg/L, all significantly lower than 【(86.4±11.5)U/L, (112.2±9.3)μg/L, (2.3±0.9)mg/L, (2.1±1.2)mg/L, (61.3±9.8)U/mL and (4.7±0.8)mg/L, respectively, P<0.05】 in patients receiving open hepatectomy; the incidence of complications after operation in the interventional group was 13.3%, which was obviously lower than that in the open hepatectomy group (30.0%, P<0.05); the total effective rate in the interventional group at six-month follow-up was 93.3%, which was obviously higher than that in the open hepatectomy group (80.0%, P<0.05). Conclusion The transhepatic artery embolization in the treatment of patients with hepatic hemangioma is efficacious, which might reduce serum GPDA, GP73 and β2-MG levels, and lead to less post-operational complications.

Objective The aim of this study was to investigate the efficacy of ultrasound-guided percutaneous catheter aspiration and sclerotherapy with polygui alcohol foam in the treatment of patients with simple hepatic cyst (SHC). Methods 112 patients with SHC were randomly divided into observation group (n=56) and control group (n=56), and the patients in the observation group were treated with ultrasound-guided percutaneous catheter drainage with polygui alcohol foam sclerosis and those in the control group were treated with ultrasound-guided percutaneous catheter drainage with 1% lauromacrogol sclerotherapy. All patients were followed-up for six months. Serum C-reactive protein (CRP) level was detected by chemiluminescence method, serum cortisol (Cor) level was detected by magnetic particle chemiluminescence method, and blood glucose (GLU) level was detected by hexokinase method. Results Six months after operation, the total effective rate in the observation group was 100.0%, which was not statistically different compared to 92.9% in the control group (P>0.05); the incidence of adverse reactions in the observation group was 5.4%, which was significantly lower than 19.6% (P<0.05) in the control group; 1 week after treatment, serum bilirubin, alanine aminotransferase, aspartate aminotransferase, ALP, CHE, CRP, cortisol and blood glucose levels in the two groups were not significantly different (P>0.05). Conclusion Ultrasound-guided percutaneous puncture with catheter drainage and polygui alcohol foam sclerosis in treatment of patients with simple hepatic cysts is efficacious, which might decrease the side effects and is a safe procedure, warranting further clinical application.

Objective The purpose of this study was to investigate the application of segmental hepatectomy for the treatment of patients with hepatolithiasis and effect on serum leukotriene (LTB4) and hepatic carbon monoxide (CO) levels. Methods 60 patients with hepatolithiasis were admitted to our hospital between June 2015 and December 2019, and were randomly divided into observation (n=30) and control group (n=30). The patients in the observation group were treated with segmental hepatectomy, and those in the control group were treated with B-ultrasound-guided hepatectomy. Serum LTB4 and liver tissue CO were detected and compared in the two groups. Results The bleeding volume in the observation group was (351.7±104.2) mL, significantly lower than [(492.6±153.8)mL, P<0.05], and the drainage volume was (279.8±79.2) mL, much lower than [(361.7±113.7)mL, P<0.05] in the control; serum LTB4 level was (22.6±11.7) ng/L/l, significantly lower than t [(43.5±12.2) ng/L/l, P<0.05], and hepatic CO concentration was (41.3±5.8) ppm, much lower than [(65.5±4.3) ppm, P<0.05] in the control; the incidence of complications in the observation group was 23.3%, significantly lower than 50.0% in the control group (P<0.05). Conclusion The application of segmental hepatectomy could effectively reduce intraoperative blood loss, post-operational drainage, serum LTB4 level and hepatic CO concentration in patients with hepatolithiasis, which might be related to the inhibition of inflammatory reactions.

Objective Bile acid(BA) is synthesized in the liver and is the major component of bile. BAs accumulates in serum and liver when BAs secretion is impaired, which is followed by liver injury. The molecular mechanism of cholestasis has been extensively studied, however, it remains controversial. Recent studies showed that BAs might induce hepatocyte injury under pathological conditions, and the mechanism involved inflammatory response induced by stressed hepatocytes. In this article, we reviewed recent advances in the pathogenesis of liver injury induced by BAs and we focused on how BAs induce the activation of inflammatory cytokines that further induce the aggregation of immune cells. Based on these pathogenesis, we tentatively point out a number of novel treatments for cholestatic liver damage.